The suicidal continuum: a review of the factors differentiating high and low lethality suicide attempts in older adults and an empirical exploration of the ideation-action gap within IAPT

Barker, Joseph (2022) The suicidal continuum: a review of the factors differentiating high and low lethality suicide attempts in older adults and an empirical exploration of the ideation-action gap within IAPT. Doctoral thesis, University of East Anglia.

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Abstract

Five chapters are contained within this portfolio. Firstly, an introduction to the suicidal continuum outlines the ideation-action theoretical framework on which this thesis is based. Given most well-established risk factors for suicide do not distinguish those who think about suicide from those who make attempts, the framework posits that distinct factors engender suicidal ideation and lead an individual to act. Furthermore, it highlights that suicide attempters are not a homogenous population and emphasises the importance of empirically investigating distinct suicidal subgroups.

The second chapter is informed by the principles outlined in the ideation-action framework. It comprises a systematic review and meta-analysis summarising the factors that distinguish suicide attempters who make suicide attempts of high and low medical lethality within an older adult population. The meta-analysis found suicidal intent and planning meaningfully distinguished high and low-lethality attempters while, contrary to adult populations, gender and age did not. A distinct pattern of differences in executive functioning is discussed and the author suggests high-lethality attempters are less prone to acting on suicidal urges, instead delaying their attempts which are subsequently better planned and more lethal.

After a bridging chapter, an empirical article examines the ability of the Improving Access to Psychological Therapies (IAPT) risk assessment protocol to distinguish those who present with suicidal ideation at assessment, and those who attempt suicide within the following two years. Past suicide attempts and non-suicidal self-injury distinguished ideators and attempters, while the intensity of suicidal ideation (passive death wish verses active intent) did not. The IAPT Phobia Scale correctly classified 49.30% of suicide attempters, with a two-point increase tripling the odds of a suicide attempt within two years.

Finally, a critical discussion examines the work as a whole, presents a novel theory of the role of experiential avoidance in suicide, and outlines directions for future research.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	Chris White
Date Deposited:	03 Nov 2022 09:10
Last Modified:	03 Nov 2022 09:10
URI:	https://ueaeprints.uea.ac.uk/id/eprint/89538
DOI:

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